A Neurosurgical Instrument Segmentation Approach to Assess Microsurgical Movements.

The ability to recognize anatomical landmarks, microsurgical instruments, and complex scenes and events in a surgical wound using computer vision presents new opportunities for studying microsurgery effectiveness. In this study, we aimed to develop an artificial intelligence-based solution for detecting, segmenting, and tracking microinstruments using a neurosurgical microscope. We have developed a technique to process videos from microscope camera, which involves creating a segmentation mask for the instrument and subsequently tracking it.

Computer Vision for Assessing Surgical Movements in Neurosurgery.

Objective evaluation of microsurgical technique quality is vital for successful training in neurosurgery. This study aimed to assess the accuracy of automatically detecting a neurosurgeon's proper posture and hand positioning using computer vision. We employed the RTMPose neural network model to identify key anatomical points in the neurosurgeon's projection and calculated various angles formed by connecting these points.

A novel low-cost device for tool targeting training and microsurgical hand tremor assessment.

Background: The spatial accuracy of microsurgical manipulations is one of the critical factors in successful surgical interventions. The purpose of this study was to create a low-cost, high-fidelity, and easy-to-use simulator for microsurgical skills training, which can be made by residents themselves at home.

Methods: In response to the COVID-19 pandemic, we created a device for spatial accuracy microsurgical skills training and implemented it in our resident's training program.

Transsylvian Insular Glioma Surgery.

Currently, there is a unanimous opinion that the first line of the treatment of insular gliomas is microsurgical removal. At the same time, surgery of insular glial tumors remains a challenge because of the complex anatomy of the insular region. Among the most crucial anatomical structures are branches of the middle cerebral artery (MCA), lenticulostriate arteries (LSAs), and corticospinal tract.

Perifocal Zone of Brain Gliomas: Application of Diffusion Kurtosis and Perfusion MRI Values for Tumor Invasion Border Determination.

(1) Purpose: To determine the borders of malignant gliomas with diffusion kurtosis and perfusion MRI biomarkers. (2) Methods: In 50 high-grade glioma patients, diffusion kurtosis and pseudo-continuous arterial spin labeling (pCASL) cerebral blood flow (CBF) values were determined in contrast-enhancing area, in perifocal infiltrative edema zone, in the normal-appearing peritumoral white matter of the affected cerebral hemisphere, and in the unaffected contralateral hemisphere. Neuronavigation-guided biopsy was performed from all affected hemisphere regions.

Neurosurgical skills analysis by machine learning models: systematic review.

Machine learning (ML) models are being actively used in modern medicine, including neurosurgery. This study aimed to summarize the current applications of ML in the analysis and assessment of neurosurgical skills. We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Sensitivity of three-dimensional time-of-flight 3.0 ​T magnetic resonance angiography in visualizing the number and course of lenticulostriate arteries in patients with insular gliomas.

Background: Neurosurgical resection of insular gliomas is complicated by the possibility of iatrogenic injury to the lenticulostriate arteries (LSAs) and is associated with devastating neurological complications, hence the need to accurately assess the number of LSAs and their relationship to the tumor preoperatively.

Methods: The study included 24 patients with insular gliomas who underwent preoperative 3D-TOF MRA to visualize LSAs. The agreement of preoperative magnetic resonance imaging with intraoperative data in terms of the number of LSAs and their invasion by the tumor was assessed using the Kendall rank correlation coefficient and Cohen's Kappa with linear weighting.

Anatomical and Technical Preparations of the Human Brain for White Matter Fibers Dissection with Electromagnetic Neuronavigation Assistance Technical Nuances for Application.

Background: Klinger's fiber dissection technique is widely used for studying the anatomy of white matter. Herein, we present a technical description of Klinger's proposed fiber dissection algorithm with neuronavigation assistance which allows for a more accurate determination of the projection of association fibers.

Methods: An anatomical study was conducted on 8 hemispheres of the human brain, prepared according to the Klingler fiber dissection technique.

Fourth Ventricle Tumors: A Review of Series Treated With Microsurgical Technique.

Tumors of the IV ventricle represent 1-5% of all intracranial lesions; they are implicated in 2/3 of the tumors of the ventricular system. According to modern standards, the first treatment stage for this pathology is microsurgical removal. Currently, for the removal of neoplasms of the IV ventricle and brainstem, the median suboccipital approach is widely used, followed by one of the microapproaches.

Prediction of Postoperative Speech Dysfunction Based on Cortico-Cortical Evoked Potentials and Machine Learning.

The possibility of postoperative speech dysfunction prediction in neurosurgery based on intraoperative cortico-cortical evoked potentials (CCEP) might provide a new basis to refine the criteria for the extent of intracerebral tumor resection and preserve patients' quality of life. In this study, we aimed to test the quality of predicting postoperative speech dysfunction with machine learning based on the initial intraoperative CCEP before tumor removal. CCEP data were reported for 26 patients.

Neuromonitoring of the language pathways using cortico-cortical evoked potentials: a systematic review and meta-analysis.

Cortico-cortical evoked potentials (CCEPs) are a surge in activity of one cortical zone caused by stimulation of another cortical zone. Recording of CCEP may be a useful method of intraoperative monitoring of the brain pathways, particularly of the language-related tracts. We aimed to conduct a systematic review and meta-analysis, dedicated to the clinical question: Does the CCEP recording effectively predict the postoperative speech deficits in neurosurgical patients? We conducted language-restricted PubMed, Google Scholar, Scopus, and Cochrane database search for eligible studies of CCEP published until March 2021.

Effects of exogenous factors on spatial accuracy in neurosurgery.

The study aimed to assess the effect of exogenous factors such as surgeon posture, surgical instrument length, fatigue after a night shift, exercise and caffeine consumption on the spatial accuracy of neurosurgical manipulations. For the evaluation and simulation of neurosurgical manipulations, a testing device developed by the authors was used. The experimental results were compared using nonparametric analysis (Wilcoxon test) and multivariate analysis, which was performed using mixed models.

Complication avoidance: resection of the insular glioma complicated by iatrogenic injury to the lenticulostriate artery.

Background: Neurosurgical resection of insular gliomas is complicated by the risk of iatrogenic injury to lenticulostriate arteries (LSAs).

Method: We provide a description, figures, and a video to illustrate the clinical case in which the LSA was damaged during the resection of insular glioma. Cadaveric dissection from our anatomical laboratory and our 3D anatomical model provided relevant surgical anatomy of the insula.

Treatment of postoperative vasospasm with intraarterial verapamil after removal of intracranial tumor: patient series.

Background: The authors report on four clinical cases with intraarterial verapamil administration to resolve vasospasm in patients who underwent surgery for intracranial tumors. Iatrogenic subarachnoid hemorrhage after tumor resection and subsequent vasospasm (an increase in the systolic linear velocity of blood flow through the M1 segment of the middle cerebral artery of more than 250 cm/sec; Lindegaard index: 4.1) were observed in four patients during the early postoperative period after the removal of intracerebral tumors.

Transsylvian Insular Glioma Surgery: New Classification System, Clinical Outcome in a Consecutive Series of 79 Cases.

Background: Surgery of insular glial tumors remains a challenge because of high incidence of postoperative neurological deterioration and the complex anatomy of the insular region.

Objective: To explore the prognostic role of our and Berger-Sanai classifications on the extent of resection (EOR) and clinical outcome.

Methods: From 2012 to 2017, a transsylvian removal of insular glial tumors was performed in 79 patients.

Burr Hole Microsurgery for Intracranial Tumors and Mesial Temporal Lobe Epilepsy: Results of 200 Consecutive Operations.

Objective: Recently, in modern neurosurgery, a tendency toward low-traumatic surgical approaches has become clear. To provide a minimal degree of injury to the brain tissue, we have offered microsurgical approaches through a burr hole.

Methods: From February 2016 to November 2017, 200 microsurgical interventions through a single burr hole with a diameter of 14 mm were performed.

Brain Mesh: Technical Note.

Background: Standard electrostimulation cortical mapping includes application of electrical current to the explored areas through an electrode and marking of functional zones by means of paper tags with different symbols. This approach has several disadvantages. First, the electrode is moved randomly.

Cisterna magna arachnoid membrane suturing decreases incidence of pseudomeningocele formation and incisional CSF leakage.

Objective: A pseudomeningocele and an incisional cerebrospinal fluid leak are considered frequent complications following neurosurgical operations. The rate of these complications especially increases following neurosurgical procedures on the posterior cranial fossae. According to some publications, the rate of pseudomeningoceles has been reported as high as 40%, whereas that of incisional cerebrospinal fluid leaks is up to 17%.